European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Meta Analysis
Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis.
Choosing an optimal distal fusion level for adult spinal deformity (ASD) is still controversial. To compare the radiographic and clinical outcomes of distal fusion to L5 versus the sacrum in ASD, we conducted a meta-analysis. ⋯ Our meta-analysis suggested that long fusion terminating at L5 or the sacrum was similar in scoliosis correction, overall complication rate, revision rate, and improvement in pain and disability. However, fusion to L5 had advantages in lower rate of pseudarthrosis, implant-related complications, and proximal adjacent segment disease, while fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance, and absence of distal adjacent segment disease. These slides can be retrieved under Electronic Supplementary Material.
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To update evidence of diagnostic potential for identification of lumbar spinal stenosis (LSS) based on demographic and patient history, clinical findings, and physical tests, and report posttest probabilities associated with test findings. ⋯ Outside of one study that was able to completely rule out LSS with no functional neurological changes none of the stand-alone findings were strong enough to rule in or rule out LSS. These slides can be retrieved under Electronic Supplementary Material.
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To update evidence of diagnostic potential for identification of lumbar spinal stenosis (LSS) based on demographic and patient history, clinical findings, and physical tests, and report posttest probabilities associated with test findings. ⋯ Outside of one study that was able to completely rule out LSS with no functional neurological changes none of the stand-alone findings were strong enough to rule in or rule out LSS. These slides can be retrieved under Electronic Supplementary Material.